What to expect from a non-suspicious prostate MRI? A review

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Multiparametric MRI (mpMRI) is increasingly recommended for prostate cancer diagnosis.
• Clinical decisions for men with non-suspicious mpMRI (Likert/PIRADS 1-2) remain variable.
• Understanding the role of mpMRI in guiding biopsy decisions is crucial.

Purpose of the Study:

• To review recent literature on mpMRI for prostate cancer.
• To determine if systematic biopsy is needed for non-suspicious mpMRI.
• To identify predictive factors for biopsy decisions and understand MRI-invisible cancers.

Main Methods:

• A narrative review of Medline database searches.
• Keywords included "MRI", "prostate cancer", "diagnosis", "biopsy", "non-suspicious", "negative", "invisible", and "MRI visible".
• Studies published within the last 5 years in English were assessed.

Main Results:

• mpMRI has a high negative predictive value (NPV) for clinically significant prostate cancer (76-99%).
• PSA density (PSAd < 0.15 ng/ml/ml) is a key factor in deciding on biopsy for non-suspicious mpMRI.
• MRI-invisible tumors exhibit distinct histopathological and genetic profiles.

Conclusions:

• mpMRI demonstrates high diagnostic accuracy for prostate cancer.
• PSA density aids in selecting patients for biopsy after a negative mpMRI.
• Further research into MRI visibility mechanisms and genetics will enhance risk assessment tools.